Triumph and tragedy: anemia management in chronic kidney disease.
OBJECTIVE
Recent trial data have resulted in a reevaluation of the management of anemia in chronic kidney disease, including the use of erythropoiesis-stimulating agents, intravenous iron, and novel pharmaceuticals. In this review, we evaluate the latest research on anemia management in chronic kidney disease.


RESULTS
Clinical trials of erythropoiesis-stimulating agents indicate that targeting the complete correction of anemia in patients with chronic kidney disease results in a greater risk of morbidity and mortality despite improved hemoglobin and quality of life. Conversely, intravenous iron has been found effective and relatively well tolerated in treating anemia in chronic kidney disease, even in patients with elevated ferritin. New agents to manage anemia, including long-acting erythropoietin derivatives, are also in active development.


CONCLUSIONS
Erythropoiesis-stimulating agents should be used to target hemoglobin 11-12 g/dl in patients with chronic kidney disease. Intravenous iron may be beneficial for patients with hemoglobin less than 11 g/dl and transferrin saturation less than 25% despite elevated ferritin (500-1200 ng/ml). An upcoming placebo-controlled trial of darbepoetin should help to define the role of erythropoiesis-stimulating agents in chronic kidney disease.
Novak
James E
JE
Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan 48202, USA. jnovak2@hfhs.org
Szczech
Lynda A
LA
D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002908:Chronic Disease; D004920:Erythropoiesis / Q000187:drug effects*; D006397:Hematinics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007275:Injections, Intravenous; D058085:Iron Compounds / Q000627:therapeutic use; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D006435:Renal Dialysis; D016896:Treatment Outcome
D006397:Hematinics; D006454:Hemoglobins; D058085:Iron Compounds